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Baylor > Prehealth > News
Medicine, Literature, Philosophy: Combining Our StoriesApril 28, 2006
By Claudia Beal
Source of Article: COLLEGIUM , A Publication of Baylor University, College of Arts & Sciences, 2000. PP 2-8.
"THEIR STORY, YOURS, MINE -
-- WILLIAM CARLOS WILLIAMS
Each fall, Baylor students gather around a table in the library of the philosophy department to explore the human dimension of illness and disability. They do so as part of an innovative upper-level seminar, "Literary and Philosophical Perspectives on Medicine," which integrates the three disciplines of philosophy, literature, and medicine. Teaching the course are Dr. S. Kay Toombs, associate professor of philosophy, Ann Miller, professor and Master Teacher of English, and Dr. William Hillis, a physician and Distinguished Professor of biology, who have collaborated for seven years to examine the manner in which the humanities and the sciences relate to one another within the context of clinical medicine.
During the semester, students -- the majority of whom are premed/science majors -- are introduced to phenomenology, a philosophical perspective that focuses on how individuals experience the world. Much of the philosophy content for the class is based on Dr. Toombs' seminal work in the field of the phenomenology of illness. Her book, The Meaning of Illness: A Phenomenological Account of the Different
Perspectives of Physician and Patient , serves as a text for the class. In addition, Dr. Toombs brings her experiences with chronic illness, multiple sclerosis, to the classroom.
Using phenomenology as a framework, issues such as the differing perspectives of physician and patient, the subjective experience of the body during illness, and the distinction between the scientific approach and immediate experience are explored. The study of a range of literary works, medical texts, and personal narratives complement the philosophical examination of illness.
In the following discussion, moderated this spring by Dean Wallace Daniel of the College of Arts and Sciences, professors Toombs, Miller, and Hillis discuss the origins of the course, the value of interdisciplinary study, and the manner in which the sciences and the humanities can inform one another.
A conversation among scholars (left to right): Dr. William Hillis, Dr. S. Kay Toombs, Professor Ann Miller, and Dr. Wallace Daniel
Wallace Daniel : The course you offer is one of our finest, most innovative courses. Think back to the beginning of the course, its origins, and the initiatives you took. How did your efforts begin?
Kay Tombs : Ann Miller and I were thinking about how it was important to bring the humanities into medicine. We started having a conversation about literature and medicine and how that conversation might fit with philosophy and medicine. We spent days and weeks and months coming up with the kinds of topics we wanted to address and then looking for the literature.
Ann Miller : I felt so strongly that literature has a place in the context of philosophy and medicine. The goal of literature is to convey knowledge feelingly , knowledge of the human condition, or what Faulkner refers to as the "problems of the human heart in conflict with itself."
Toombs : Then we really felt we needed someone who knew a lot about medicine. We talked to Bill Hillis about how we might incorporate clinical medicine into the course and combine the three disciplines.
William Hillis : I was most enthusiastic when I heard about the course. I realized that there were many applications of this material for students in actual clinical practice.
Toombs : To my knowledge, this course is unique in undergraduate education.
Daniel : As you think through the organization of the course, what main themes stand out in what you most wanted to accomplish?
Toombs : Part of it was informed by the work that I was doing in phenomenology, and so our goal for the course was for students to understand the human experience of illness. We thought about that in terms of the nature of suffering, the experience of the body, the experience of disability, and aging.
Miller : We discuss mental illness, AIDS, and controversial issues like euthanasia. And doctor/patient relationships. This part, of course, is very important.
Toombs : And the goals of medicine, which include the difference between the healing and curing of a disease.
Miller : One of the finest sections we have is on current medical discoveries such as stem cell research and cloning. We also give the students a practical assignment: imagine going across campus, blind or disabled in some way, say in a wheelchair. How do they get from one place to another? Can they get a second-story apartment? What do they do about bathroom facilities? What do they do about curb cuts for wheelchairs?
Toombs : We also incorporate clinical data. When we talk about the experience of, say, Parkinson's disease or some other disability, Bill addresses the clinical aspects of the disease.
Hillis : Yes, and most of the illnesses we discuss are ones I've dealt with in my practice, and I have known patients who have under-gone the suffering that is associated with those illnesses. It is always helpful to communicate about my relationship with the patient.
Toombs : In conjunction with that, students research the clinical and medical data of a particular disease. They then have to convey the information to us as if we were the patient, tell us what the problem is in words that we can understand. A student also writes a narrative about somebody who has the illness, which conveys what the experience of having that illness is like.
We start the course by showing a video in which doctors talk about their own experience of cancer or their experience of cancer in their families. They discuss how their experience has changed the way they practice medicine. We begin the course with that so that immediately students can see the relevance. It is a very powerful film.
Daniel : Each of you is a highly accomplished, highly dedicated teacher. What special qualities, interests, questions do you bring to this particular task and subject?
Toombs : One of the things that has really helped us in this class is our different backgrounds. Bill's a physician. I combine the first-hand experience of chronic illness with my philosophical training in phenomenology. Of course, Ann is so rich in literature. She found the wonderful literature for us.
Hillis : I want to point out here that in the course of medical education, no one really gets an opportunity to do much in the way of chronic disease. You see a patient at one period of time in an illness, and you don't really have any sense of what happens throughout a lifetime. Kay, out of her own personal experience with multiple sclerosis, has given these students a wonderful opportunity to understand chronic illness as it affects the individual over a long course of time.
Miller : She is a living example for the course. She is our linchpin, there is no doubt about it.
Toombs : My life experience has influenced my work in such a way that I cannot separate the two. The whole focus of my work has been to show the difference between the patient's experience and the physician's perspective. I began this work when I spoke as a patient to physicians and was puzzled at their responses. We seemed, even though talking about the same thing, in effect to be talking about two different things. That has been the whole impetus for my work and has become what this course has crystallized around -- to show these two perspectives.
Hillis : So many times the mental attitude of caregivers is focused on a disease and there doesn't seem to be a lot of inclination to spend time with emotions. But we can't talk about illness with out talking about feelings. I think it means a lot to the medical students to know that I, as a physician, hurt very, very deeply when a patient is dying and there is nothing that I have to give them. It used to be that this was a sense of defeat for me, but I think Kay, more than anybody else, has helped me to understand that caring is as important as anything else we can do. Even though I cared a great deal, I never realized how much that meant to patients.
Miller : The wonderful thing about this course is that we three have worked together in ways that are incredible. We have no sense of possessiveness or jealousy or competitiveness. We are each there for the course all the time.
Hillis : It is true collegiality.
Daniel : What are two or three readings from the course that stand out most to you and why?
Miller : Well, for me it is Alexander Solzhenitsyn's Cancer Ward . It is a sympathetic view of doctors in Russia and the way they have to work within the confines of the system. And it's about patients who have come to a common level of mortality and about their attitudes, how each of them approaches his death and his illness in a totally different way. It is one of the great books.
Toombs : We do some-thing very unusual with Franz Kafka's The Metamorphosis . The students read that story just as we talk about the experience of disability. They have already thought about how space and time are altered when one is ill, the way we experience bodily change, and the way our relationship with other people changes. They read Kafka's The Metamorphosis and think about it in terms of a radical experience of the changing body. It provides some very interesting insights.
The other one that I like very much is The Plague by Albert Camus. We have the students look at this work from the perspective of the ethical issues that arise for doctors caring for patients during an epidemic. We ask one student to trace the existential themes, as well.
Hillis : The Things They Carried by Tim O'Brien is a powerful story, so personalized, about the experiences of young soldiers in Vietnam. It really gives the students an awful lot of insight into suffering.
Also, one of the things that really touched me was Dr. David Hilfiker's essay, "Mistakes," in which he confesses the errors he had made as a physician. I don't think that is some-thing often discussed by physicians. There was a huge response when it was published.
Miller : We all, of course, think "The Death of Ivan Ilych" by Leo Tolstoy is the greatest. It gives so many insights into the experience of illness and the changed relationship with others and the different ways in which doctor and patient look at illness.
Hillis : And Ken Kesey's One Flew Over the Cuckoo's Nest .
Miller : The students do an oral presentation on one of the major works. Students are responsible for leading the discussion, and one of the things they can do is bring movie clips. The film always brings to life One Flew Over the Cuckoo's Nest .
Daniel : You talked about your students. By engaging students in the process of seeking to create something beautiful that will inspire and endure, the arts and sciences compel students to grapple with, as Ann said earlier, what Faulkner called the problems of the heart in conflict with itself" What has been the experience of your students? What have they told you about the course?
Toombs : I don't think we have ever had a bad evaluation from the students. The comments that they make are things like "this is the best reading I have ever done, this is the best course I have ever taken, this is the one course I will remember." By engaging the material, it is impossible for them not to have a life-changing experience. Obviously, there are some students who come out more aware than others, but I can't really think of one who was not changed at all.
Hillis : Some, I think, come in with the notion that they won't be involved with patients' emotions in any way. I think students come to recognize how important it is for patients to have the opportunity to talk with somebody about their experience.
Toombs : One of the things that I am very concerned about when teaching this class is that, if you talk about ethical issues, you need to ground them in real-life experiences. I particularly want students to consider ethical dilemmas in the context of real-life situations and not merely as abstract arguments. I think about a film we show, which is deeply disturbing, about a physician in Holland who performs euthanasia, and the struggle he goes through. The students see what a serious decision this is.
Miller : Students are exposed to things that previously had not been within the scope of their young, invulnerable lives. Their reactions are moving to watch.
Toombs : I do think one of the most wonderful things for us in this class is to see how our students change throughout the course of the semester. They are healthy and exuberant and can-not understand what all this illness is about. They really have a much greater understanding by the end of the course. It is incredible, I think.
Hillis : Students get more insight in this course than any other course I've been associated with. Their final paper always has to do with an individual who is experiencing chronic illness in some way or another, either a physician or a patient or a relative. Everything the student has thought about and had insight about comes to form as they write these papers. They really are pieces of art, pieces of autobiography, too.
Toombs : One thing that has been interesting about the course is that many of the students, at the time they are taking this class, also are going for medical school interviews. It has been our experience that medical schools are very interested in this course, and the students love to have an opportunity to talk about it.
Hillis : The most that I can remember of medical education is the complete focus on being a good physician, but there is so little emphasis on being a good human being. This course gives us an opportunity to let young people think about these things.
Toombs : Most students who go into medicine really want to help people. The problem is they get into medical school and the focus is all on the clinical data. By the time they get through, much of the original feeling they had about medicine has gone. We try to get them before they get into medical school and hope they don't forget what they've been exposed to in this class.
Daniel : Taking the course as a model, how might we better relate the sciences to the humanities, and the humanities to the sciences?
Miller : First, professors in the humanities can be helped to understand the debt we owe to science, to become more keenly aware what DNA and stem cell research, for example, can mean to our everyday lives. Those in the sciences might more fully realize what history, religion, literature, theater -- what we call the humanities -- are, and how they have always been essential to humankind. Without these dimensions, life would be diminished. Perhaps these ideas can be explored in a faculty development session. Also, the history department will soon be offering a history of medicine course -- a course embodying both science and the humanities. What better way for faculty and students to see the interweaving of these seemingly disparate areas?
Hillis : The basic issues we deal with in this class are concerned with human relationships. It seems to me that one of the major contributions that the humanities can offer science majors is insight into the way science affects human lives and relation-ships.
Toombs : It also occurs to me that clinical medicine is very clearly a discipline that spans science and human experience. Medical education has traditionally focused mainly on the sciences and has de-emphasized the human experience of illness. So this particular area really lends itself to a kind of integration.
Hillis : Science tends to focus on objective detail and can miss the forest for the trees. The course gives an opportunity to enjoy the forest.
Toombs : I think in order to do this kind of integration, you have to have an open mind as to what the goals of the class are. If you have narrowly defined categories in terms of what is necessary for it to count as a science course or philosophy course or an English course, then you are going to defeat the objective from the beginning.
Miller : Books that dramatize the experience of the scientist and doctor and the human beings who need them could be taught in the sciences as well as in the Department of English. There are fine scientists who write with astonishing grace and clarity, such as J. Bronowski and Lewis Thomas. The poet W. H. Auden has fine essays on medicine. This approach would not compete with, but enhance, the empirical data and the clinical method.
Hillis : I think there is also a great opportunity at the freshman level to do the kind of thing we are talking about, because there are so many applications of biology in everyday living.
Miller : Both the arts and sciences work to bring order out of chaos. We both demand evidence to support our conclusions. We have more in common than we know.
Student Comment - Mari Rebane, B.A. '98, Yale Medical School
"The course totally changed my understanding of what matters in medicine because it showed the human side. You must, of course, have a good foundation in science, but most important to a patient is that you want to know his story, that you listen to him. You Must earn the patient's trust."
List of Readings for "Literary and Philosophical Perspectives on Medicine"
Camus, Albert. The Plague.
Frank, Arthur W. At the Will of the Body: Reflections on Illness.
Hilfiker, David. Not All of Us Are Saints: A Doctor's Journey with the Poor.
Kafka, Franz. The Metamorphosis.
Kesey, Ken. One Flew Over the Cuckoo's Nest.
Mandell, Harvey and Howard Spiro. When Doctors Get Sick.
Miller, Arthur. Death of a Salesman.
O'Brien, Tim. The Things They Carried.
Olsen, Tillie. Tell Me a Riddle.
Osier, William. Aequanimitas.
Remen, Rachel (ed). Wounded Healers.
Reynolds, Richard, John Stone, and Lois Lacivita Nixon (eds). On Doctoring: Stories, Poems, Essays.
Sacks, Oliver. Awakenings.
Sacks, Oliver. The Man Who Mistook His Wife for a Hat.
Sacks, Oliver. An Anthropologist on Mars: Seven Paradoxical Tales.
Selzer, Richard. Mortal Lessons: Notes on the Art of Surgery.
Selzer, Richard. Letters to a Young Doctor.
Solzhenitsyn, Alexander. Cancer Ward.
Thomas, Lewis R. The Medusa and the Snail: More Notes of a Biology Watcher.
Tolstoy, Leo. The Death of Ivan Ilych.
Toombs, S. Kay. The Meaning of Illness: A Phenomenological Account of the Different Perspectives of Physician and Patient.
Williams, William Carlos. The Doctor Stories.
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